Treatment

Depending on the extent of the acne problem, the doctor may recommend one of several over-the-counter (OTC) medicines and/or prescription medicines. Some of these medicines may be topical (applied to the skin), and others may be oral (taken by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medicines.

Treatment for Blackheads, Whiteheads, and Mild Inflammatory Acne

There are several OTC topical medicines used for mild acne. Each works a little differently. Following are the most common ones:

• Benzoyl peroxide - destroys P. acnes, and may also reduce oil production.
• Resorcinol - can help break down blackheads and whiteheads.
• Salicylic acid - helps break down blackheads and whiteheads. Also helps cut down the shedding of cells lining the hair follicles.
• Sulfur - helps break down blackheads and whiteheads.

Treatment for Moderate to Severe Inflammatory Acne

Several types of prescription medicines are used to treat acne. They include:

• Antibiotics - help stop or slow the growth of bacteria and reduce inflammation. They include tetracycline, minocycline, doxycycline, clindamycin, erythromycin, and sulfonamides.
• Vitamin A derivatives (retinoids) - unplug existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. These drugs contain an altered form of vitamin A. Some examples are tretinoin, adapalene, and tazarotene.
• Others - may destroy P. acnes and reduce oil production or help stop or slow the growth of bacteria and reduce inflammation. Some examples are prescription strength Benzoyl peroxide, sodium sulfacetamide/sulfur-containing products, or Azelaic acid.

Treatment for Severe Nodular or Cystic Acne

For patients with severe inflammatory acne that does not improve with medicines such as those described above, a doctor may prescribe isotretinoin (Accutane), a retinoid (vitamin A derivative). Isotretinoin is an oral drug that is usually taken once or twice a day with food for 15 to 20 weeks. It markedly reduces the size of the oil glands so that much less oil is produced. As a result, the growth of bacteria is decreased.

Advantages of Isotretinoin (Accutane)

Isotretinoin is a very effective medicine that can help prevent scarring. After 15 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in most patients. In those patients where acne recurs after a course of isotretinoin, the doctor may institute another course of the same treatment or prescribe other medicines.

Disadvantages of Isotretinoin (Accutane)

Isotretinoin may cause the following side effects:

• birth defects in the developing fetus of a pregnant woman
• dry eyes, mouth, lips, nose, or skin (very common)
• itching
• nosebleeds
• muscle aches
• sensitivity to the sun
• poor night vision
• changes in the blood, such as an increase in triglycerides and cholesterol
• change in liver function.

There have been a number of reported suicides and suicide attempts in people taking isotretinoin; however, the connection between isotretinoin and suicide or depression is not known.

Reference:

National Institute of Arthritis and Musculoskeletal and Skin Diseases, USA.